So, You Had Preeclampsia In Your Last Pregnancy: How Likely Are You To Get It Again?

"Preeclampsia" — the word alone is enough to fill the minds of pregnant women and those who are trying to conceive with concern or even dread. Those who are embarking on their journey towards first-time motherhood with the help of books and web resources are sure to come across the term, learning that the condition, exclusive to pregnant humans, can quickly become life-threatening to mothers and babies alike, and that the only cure is delivering the baby.

The facts that preeclampsia can rapidly develop into an even more severe condition and that it seems to be shrouded in mystery doesn't help put pregnant women at ease one bit. Those who have already been through it once, however, are in an altogether more frightening position if they get pregnant again.

What Is Preeclampsia?

Preeclampsia is a rapidly progressing and dangerous disorder that strikes between five and eight percent of all human pregnancies, and affects both mother and baby. It typically develops after 20 weeks of pregnancy, though preeclampsia can indeed develop earlier in some cases as well as sometimes affecting women up to six weeks postpartum. The one key symptom of preeclampsia is high blood pressure.

Complications of preeclampsia include:

• Placental abruption, in which the placenta detaches from the uterine wall prior to delivery, putting both mother and baby at risk.
• Insufficient blood supply to the placenta, potentially leading to low birth weight babies and premature birth.
• Eclampsia, a very serious complication characterized by seizures that can directly cause brain damage, coma, and maternal and fetal death.
• HELLP Syndrome, a severe form of preeclampsia that can lead to liver damage, a breakdown of red blood cells, and a severely lowered platelet count. Ultimately, HELLP Syndrome can be fatal.

Headaches, weight gain, vision changes, and swelling all fit into the symptomatic picture lots of women with the condition will display — but not all of them do, and some report frighteningly few symptoms. High levels of protein in the urine, once considered the factor to differentiate preeclampsia from gestational hypertension, is no longer a diagnostic requirement. The latest data show that organ damage can occur without the presence of high levels of protein in the urine, and that urine protein levels don't predict how fast the condition is progressing either.

READ Primary Prevention of Hypertension

What Causes Preeclampsia?

Though definite breakthroughs have given us a greater insight into the root causes of preeclampsia in recent years, the underlying reason women get preeclampsia is still not fully understood.

Some of the key players likely are:

• Antiangiogenic proteins overproduced by the placenta inhibit the development of new blood vessels, a process known as "angiogenesis". Why this happens is of yet unclear.
• A lack of blood flow to the uterus during pregnancy.
• An overly inflammatory response to pregnancy.
• Several different conditions that inhibit the maintenance of blood vessels, including a calcium deficiency.
• Undiagnosed but preexisting maternal conditions including hypertension, diabetes, and lupus.
• Obesity.
• Hereditary factors.

Women who have had preeclampsia before will be worried that they are at an increased risk of developing it again in a subsequent pregnancy. Just how high is this risk, and is there any way to reduce it?

How Likely Are You To Develop Preeclampsia Again In A Subsequent Pregnancy?

The sudden onset and rapid progress of preeclampsia is a poster child for the great importance of prenatal care all by itself. In women who have already had preeclampsia before, however, the need for careful monitoring is especially large. Indeed, if you've had preeclampsia already, you are an at increased risk of developing it again.

Just how high is that risk?

The general consensus is that your risk of getting preeclampsia again is around 20 percent, though it may be as low as five percent or as high as 80 percent. Your risk depends on a lot of factors, such as whether you suffered preeclampsia in a first or subsequent pregnancy, when in your pregnancy you developed it, and how severe it was. Research has still, unfortunately, not led to a concrete risk prediction model.

What we do know is that your odds of developing preeclampsia again rise if:

• You have developed chronic hypertension since having preeclampsia.
• You have developed diabetes since having preeclampsia.
• You got pregnant with the help of IVF.
• You are carrying twins or higher multiples.

Other risk factors that apply to women regardless of whether they have had preeclampsia before include, in addition to the "first pregnancy" that does not apply to you if you have already had it:

• Kidney disease.
• Having an autoimmune disease.
• Being obese.
• Being a teenager or older than 40.
• Being a non-Hispanic Black woman.

Can You Actively Reduce Your Risk Of Preeclampsia?

Your doctor may advise you to take a daily low dose of Aspirin if you have had preeclampsia before and are at a high risk of developing it again. In addition, research shows that food bars with antioxidants and L-arginine, an amino acid, might reduce your risk — so ask your healthcare provider about those.

READ Are you at risk of developing preeclampsia?

Carefully monitoring for signs that could point to preeclampsia can help identify it early. Of course, if you have had it before and are at a significant risk of developing it again, your medical team will keep a close eye on your blood, your urine, your blood pressure, and the growth of your baby. You can, in addition, purchase a blood pressure monitor for home use, weigh yourself regularly, and keep a diary of symptoms that you can show your doctor. Do call in as soon as you notice anything worrying. This will either put your mind at ease, or allow you to receive the most timely treatment possible.

In some cases, your doctor will even advise you against getting pregnant again after a particularly severe case of preeclampsia and if you are subject to many risk factors that mean you have a high chance of recurrence. This is rare, however, and if it happens to you, you can always consult other doctors for second and third opinions to determine whether your doctor is being overly cautious, or giving you the best recommendation in your situation.